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The path of compassion in forensic psychiatry Lars Hammarströma,⁎ , Siri Andreassen Devikb , Ove Hellzéna , Marie Häggströma a Department of Nursing, Mid-Sweden University, Sundsvall, Sweden b Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway ARTICLE INFO Keywords: Compassion Encounters Forensic nursing Forensic psychiatry Hermeneutics Lived experience Nurse-patient relationship Nursing ABSTRACT We aimed to deepen our understanding of the concept of compassion in caring for patients with mental illness in forensic psychiatric inpatient care settings. Qualitative analysis was used to illuminate themes from interviews conducted with 13 nurses in a prior study. The audiotaped interviews, which had been transcribed verbatim, were analyzed following a hermeneutic approach. Results revealed the main theme of “being compassionate in forensic psychiatry is an emotional journey” and three themes. Overall, compassion was seen as a changeable asset, but also an obstacle when absent; sensitivity to one's own vulnerability is necessary to overcome that obstacle. Introduction The wellbeing of nurses is the foundation of forensic psychiatric care, which involves working with mentally disordered people who have been involved in criminal activity or have encountered other legal issues. Forensic psychiatric nursing care is often provided in prison hospitals and other secure institutions, and it can be a struggle to work with mentally ill patients in such environments and maintain good management of one's own emotions, being compassionate, consistent, and staying connected to the patients. (Sturzu et al., 2019). While challenging, providing care within a forensic setting creates unique opportunities for nurses to affect the wellbeing of patients (Rydenlund et al., 2019) and alleviate the suffering of offenders with severe mental illnesses (Nedopil et al., 2015). To be effective, this requires relationship-based care (Encinares et al., 2005; Schafer & Peternelj-Taylor, 2003). However, establishing relationships can be one of the greatest challenges for forensic nurses (Austin, 2001) as it involves making sense of an incomprehensible world and developing relationships based on empathy, genuineness, and compassion (Møllerhøj & Os Stølan, 2018; Wyder et al., 2015). According to Kanov et al. (2004), compassion is a process involving three key elements: “noticing” another's suffering, “feeling” the others pain, and “responding” to that persons suffering. It is also described as an intentional response to gain an in depth understanding of a person, recognize their needs, and ameliorate suffering through relational understanding and action (Sinclair et al., 2018). Letting compassion guide your actions towards the suffering of others goes beyond gaining the attention of the other to attuning to oneself and engaging an ethical compassion-based action (Halifax, 2014). Compassion and self-compassion is closely linked, as it involves admitting that suffering, failure and inadequacies are part of being human, that all people, oneself included, are worthy of compassion (Neff, 2003). Compassion is re-emerging as a major topic in the domain of ensuring quality in care (Tveit & Raustol, 2017). Studies indicate the importance of nurse's attuning to vulnerability when taking part in the lives of others (Hammarström et al., 2019). Lögstrup (1997) states that vulnerability is a fundamental condition of human life, meeting another person is an interhuman act, where both parties should be guided by their sensitivity. Conversely, not being able to compassionately understand expressions of suffering can obstruct the building of stronger relationships and thus hinder a patient's